CASE PRESENTATION

MADE BY : Ali Hassan Alhabib

191120076
 Sham 52 days old Syrian girl
DEMOGRAPHIC Lives in manfouha

DATA Her father work as taxi driver

History was taken from her mother
 She suffers from white color stool and dark urine
CHIEF COMPLAIN Yellow skin and eye for 1 month
 Symptoms started 5 days after birth

HISTORY OF PRECENT Sudden in onset

no reliving or aggravating factors
ILLNESS Not related to time and no associated symptom
The family first went to private dispensary care
And was seen by general pediatrician who diagnosed
her with physiological jaundice.
 CNS: No seizure, no abnormal
movement no fever
Respiratory system: no cough, no nasal
congestion normal RR
SYSTEMIC CVS: normal breast feeding no
REVIEW cyanosis
Git: abdominal distension, constipation,
vomiting what drink (milk color).
Dermatology: no skin rash
 took all vaccine required for her age
VACCINATION No extra vaccine.
 Medication : Nospasm (hyoscine n) .Pico (picosulfate
sodium) Bebe vit (multi vitamin) given by pharmacist

Diseases: No known any disease

PAST MEDICAL No history of blood transfusion

No allergies

No record of surgery.
FAMILY HISTORY AND
SOCIAL
Family have history of T2DM,HTN

No history of asthma or any congenital disease

-ve consanguinity

Have 2 normal brothers

No history of traveling

Poor socioeconomic
 Antenatal history: mother aged 28 during pregnancy Took folic
acid and vitD complete pregnancy without any complications
with regular follow up and normal fetal movement and did not
expose to any radiation , not asmokers , no medication.

Natal: full term 38week , c section due to decrease amniotic

fluid

PRENATAL
HISTORY Birth weight was 2.6kg

post natal: normal.

NUTRITIONAL
HISTORY
Breast feeding first two week than Formula feeding
 Primitive reflexes

Asymmetrical tonic neck reflex

DEVELOPMENT head lag when pilled to sitting position

follow moving object

social contact listen to music and says

nagh
 Temperature: 36.5

VITAL SIGNS HR: 148

RR: 46
 GROWTH Head circumference : 38cm

PARAMETER Weight : 3.4 kg

GROWTH PARAMETER

Bellow 3rd percentile

Height to age in 5th percentile

 Head circumference in 10th
percentile
Weight in 5th percentile
GENERAL EXAMINATION
Patient is lying supine not distress Connected to iv
lines and NG tube , pulse oximeter well hydrated,
No dysmorphic feature, jaundiced.
Hand: No clubbing no leukonychia no peripheral
cyanosis
 Respiratory : abdominothoracic breathing
GENERAL normal air entry central trachea

EXAMINATION Could not preform percussion

Auscultation normal air entry bilaterally
 Git:
Inspection : there is scar in the right hypochondriac toward
mid axillary line, distended abdomen
Could not preform palpation & percussion
Auscultation: hyperactive bowl sound
GENERAL CVS:

EXAMINATION - Palpation: apex beat is in the left 4th intercostal space at

the midclavicular line. No thrill at the four valves..
- Auscultation: s1+s2+0 normal heart sounds , no murmurs,
nor gallop.
All peripheral pulses are palpable and equal.
INVESTIGATION
 ANALYSIS RESULT REMARK
GLUCOSE RANDOM 2.7 MMOl\L Low
UREA BUN 0.2 MMOl\L Low
URIC ACID 50 µMOl\L Low
Sodium serum 133 Mmol\L Low
CHLORIDE SERUM 95 Mmol\L Low
PHOSPHORUS 0.81 Mmol\L Low
INVESTIGATION MAGNISIUM SERUM 0.99 Mmol\L High
AST 95µ\L High
ALT 58.8µ\L High
BILIRUBIN –DIRECT 102.4 µmol\L High
ALBUMIN 34.7 g\L Low
BILIRUBIN -TOTAL 119.3 µmol\L -
Indirect- bilirubin 16.9 µmol\L -
Mono 1.68 ref(0.4-1.2) Increase
WBC 16.48. ref (5-15) increase
 RADIOLOGY

Finding: absence of CBD

No evidence of bile drainage
toward bowl
 BILLIARY atresia

DIFFERENTIAL Neonatal hepatitis

Physiological jaundice
DIAGNOSIS Breast milk jaundice

Diagnosis is biliary atresia

 Biliary atresia cannot be treated with medication. A surgery
called Kasai procedure (also known as a or
TREATMENT hepatoportoenterostomy) creates a path of bile flow from
the liver into the intestine.

Post op antibiotic
Thanks